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Findings from the Alzheimer’s Association 2019 Alzheimer’s Disease Facts and Figures report released today show that, despite a strong belief among seniors and primary care physicians that brief cognitive assessments are important, only half of seniors are being assessed for thinking and memory issues, and much fewer receive routine assessments. In addition to providing an in-depth look at the latest statistics on Alzheimer’s prevalence, incidence, mortality, costs of care, and impact on caregivers nationally and in North Carolina, the new Facts and Figures report examines awareness, attitudes, and utilization of brief cognitive assessments among seniors age 65 and older and primary care physicians.

A brief cognitive assessment is a short evaluation for cognitive impairment performed by a health care provider that can take several forms — including asking a patient about cognitive concerns, directly observing a patient’s interactions, seeking input from family and friends or using short verbal or written tests that can be administered easily in the clinical setting. An evaluation of cognitive function is a required component of the Medicare Annual Wellness Visit, but findings from the report show that only 1 in 3 seniors are aware these visits should include this assessment.

The report also found, however, that among both seniors and primary care physicians there is widespread understanding of the benefits of early detection of cognitive decline and the importance of brief cognitive assessments. In fact, 82 percent of seniors believe it is important to have their thinking and memory checked, and nearly all primary care physicians (94 percent) consider it important to assess all patients age 65 and older for cognitive impairment.

“Given the enormous burden Alzheimer’s has on individuals living with the disease, their families and the country as a whole – it must remain a public health priority for North Carolina and our nation,” said Katherine L. Lambert, CEO of the Alzheimer’s Association – Western Carolina Chapter. “This report reveals that there is still a gap in seniors getting routine cognitive assessments that are critical for early detection of Alzheimer’s and other dementias. We encourage seniors and physicians to be more proactive in discussing cognitive health and doing a cognitive assessment during the Annual Wellness Visit and other routine exams.”

The Facts and Figures report also reveals a troubling disconnect between seniors and primary care physicians regarding who they believe is responsible for initiating these assessments and reticence from seniors in discussing their concerns.

The survey found that while half of all seniors (51 percent) are aware of changes in their cognitive abilities — including changes in their ability to think, understand or remember — only 4 in 10 (40 percent) have ever discussed these concerns with a health care provider, and fewer than 1 in 7 seniors (15 percent) report having ever brought up cognitive concerns on their own.

Instead, most seniors (93 percent) say they trust their doctor to recommend testing for thinking or memory problems if needed. Yet fewer than half of primary care physicians (47 percent) say it is their standard protocol to assess all patients age 65 and older for cognitive impairment. Only 1 in 4 seniors (26 percent) report having a physician ever ask them if they have any concerns about their cognitive function without seniors bringing it up first.

Nearly all physicians said the decision to assess patients for cognitive impairment is driven, in part, by reports of symptoms or requests from patients, family members and caregivers. Physicians who choose not to assess cognition cite lack of symptoms or complaints from a patient (68 percent), lack of time during a patient visit (58 percent) and patient resistance (57 percent) as primary factors.

In addition, most physicians say they welcome more information about assessments, including which tools to use (96 percent), guidance on next steps when cognitive problems are indicated (94 percent) and steps for implementing assessments efficiently into practice (91 percent).

“The Alzheimer’s Association – Western Carolina Chapter is committed to help educate physicians on best practices for conducting brief cognitive assessments and to encourage seniors to proactively discuss thinking and memory concerns with their doctor,” said Lambert. “This proactive approach with increased communication plays a critical role in early detection to ensure that affected individuals and their families have the best opportunity to plan for the future.”

By the Numbers

o 94 percent of primary care physicians consider it important to assess all patients age 65 and older for cognitive impairment.

o 82 percent of seniors believe it is important to have their thinking and memory checked.

o 50 percent – average number of senior patients that primary care physicians say they assess.

The Alzheimer’s Association Facts and Figures report also provides a look at the latest national and local statistics and information on Alzheimer’s prevalence, incidence, mortality and morbidity, costs of care and caregiving.

Prevalence, Incidence and Mortality

• An estimated 5.8 million Americans of all ages are living with Alzheimer’s dementia in 2019, including 200,000 under the age of 65.

• Of the estimated 5.8 million Americans living with Alzheimer’s dementia in 2019, 170,000 are North Carolina residents.

• By 2025 — just six years from now — the number of people age 65 and older with Alzheimer’s dementia is estimated to reach 7.1 million — an increase of 27 percent from the 5.6 million age 65 and older affected in 2019. Here in North Carolina, the estimated number of individuals with Alzheimer’s will be 210,000.

• Barring the development of medical breakthroughs, the number of people age 65 and older with Alzheimer’s dementia may nearly triple from 5.6 million to 13.8 million by 2050.

• Two-thirds of Americans over age 65 with Alzheimer’s dementia (3.5 million) are women.

• Alzheimer’s is the sixth-leading cause of death in the U.S., and it is the fifth-leading cause of death for those age 65 and older. In North Carolina, 4,289 died with Alzheimer’s in 2017, the most recent figure available.

• As the population of the U.S. ages, Alzheimer’s is becoming a more common cause of death.

Cost of Care

• Total national cost of caring for those with Alzheimer’s and other dementias is estimated at $290 billion (not including unpaid caregiving) in 2019, of which $195 billion is the cost to Medicare and Medicaid; out-of-pocket costs represent $63 billion of the total payments, while other costs total $32 billion.

• In North Carolina, the report estimated total Medicaid costs for Americans with dementia age 65 and older is $1.25 billion for 2019. In the next six years, that figure is expected to increase 28.6 percent to $1.6 billion.

• Total payments for health care, long-term care and hospice care for people with Alzheimer’s and other dementias are projected to increase to more than $1.1 trillion in 2050 (in 2019 dollars).

• In 2018, the lifetime cost of care was greater for those with dementia than those without ($350,174 versus $192,575, respectively).

Caregiving

• More than 16 million Americans provide unpaid care for people with Alzheimer’s or other dementias.

• In North Carolina, there are 473,000 caregivers. In 2018, these caregivers provided 538,000,000 total hours of unpaid care, valued at $6.8 billion.

• Nearly half of all caregivers (48 percent) who provide help to older adults do so for someone with Alzheimer’s or another dementia.

• Approximately two-thirds of caregivers are women, and one-third of dementia caregivers are daughters.

• Forty-one percent of caregivers have a household income of $50,000 or less.

• It is estimated that the U.S. has approximately half the number of certified geriatricians than it currently needs, and only 9 percent of nurse practitioners report having special expertise in gerontological care.

Full text of the 2019 Alzheimer’s Disease Facts and Figures report, including the accompanying special report, “Alzheimer’s Detection in the Primary Care Setting: Connecting Patients with Physicians,” can be viewed at alz.org/facts. To download the North Carolina Fact Sheet, click here. For multi-media support of this year’s report, visit https://tinyurl.com/ALZFactsFigures.

About 2019 Alzheimer’s Disease Facts and Figures

The Alzheimer's Association 2019 Alzheimer's Disease Facts and Figures report is a comprehensive compilation of national statistics and information on Alzheimer’s disease and related dementias. The report conveys the impact of Alzheimer’s on individuals, families, government and the nation’s health care system. Since its 2007 inaugural release, the report has become the preeminent source covering the broad spectrum of Alzheimer’s issues. The Facts and Figures report is an official publication of the Alzheimer’s Association.

About the Alzheimer’s Association

The Alzheimer’s Association is the leading voluntary health organization in Alzheimer's care, support and research. Our mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer’s®. Visit alz.org or call 800.272.3900.

About the Alzheimer’s Association - Western Carolina Chapter

The Western Carolina Chapter provides patient and family services, information and referral, education, and advocacy in the 49 central and western North Carolina counties that serves over 170,000 people currently living with Alzheimer's disease and their 473,000 caregivers in these counties. We provide a variety of services including a 24/7 Helpline, support groups, educational programs, and MedicAlert®. We offer opportunities to get involved and to make a difference. For more information about Alzheimer's disease or the Alzheimer's Association Western Carolina Chapter, visit www.alz.org/northcarolina or call (800) 272-3900. For the latest news and updates, follow us on Facebook, Twitter and Instagram.